Nursing experience of extracorporeal membrane oxygenation combined with inhaled nitric oxide in the treatment of morbid obesity with severe acute respiratory distress syndrome
10.3969/j.issn.1008-9691.2024.05.017
- VernacularTitle:体外膜肺氧合联合吸入性一氧化氮治疗重度急性呼吸窘迫综合征病态肥胖患者的护理体会
- Author:
Yuying SHEN
1
;
Yelin SHEN
1
;
Chunchang LI
1
;
Haiyan LI
1
;
Xia FU
1
;
Cheng SUN
1
;
Lifang CHEN
1
Author Information
1. 南方医科大学附属广东省人民医院(广东省医学科学院)重症医学科,广东广州 510080
- Publication Type:Journal Article
- Keywords:
Morbid obesity;
Acute respiratory distress syndrome;
Extraeorporeal membrane oxygenation;
Inhaled nitric oxide;
Case care
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(5):616-620
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the successful experience of extracorporeal membrane oxygenation (ECMO) combined with inhaled nitric oxide (iNO) in the treatment of severe acute respiratory distress syndrome (ARDS) after empyema surgery in a morbid obesity patient,and to explore the nursing points. Methods On July 3,2023,a patient was admitted to the department of intensive care unit (ICU) of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University following the failure of closed thoracic drainage and catheterization at another hospital. Using the rapid integration of the WeChat group,a multidisciplinary team (MDT) model was built. This approach enabled the professional and standardized integration of clinical data and the implementation of targeted treatments,significantly reducing response times and optimizing the overall nursing process. Results A 27-year-old male patient with morbid obesity was admitted to the hospital due to dyspnea and chest pain for more than 7 days. ① Treatment process:on July 4,the patient underwent video-assisted thoracic surgery (VATS),including right chest exploration,pleural adhesion release,and empyema,performed under general anesthesia. Two thoracic drainage tubes were retained and water-sealed bottles were connected. The drainage fluid was purulent. After the operation,the patient was short of breath and the condition was aggravated and transferred to ICU. On admission,the patient's bedside chest X-ray showed that more moist rales were heard in both lungs,especially on the right side. At 18:30 on July 10,the pluse oxygen saturation (SpO2) was 0.75-0.80,and fiberoptic bronchoscopy was performed immediately. The ventilator parameters were up-regulated,the position was changed,and 20 mg of furosemide injection was injected intravenously,the effect was not good. Attempted to perform prone position ventilation,SpO2 did not improve. At 21:30,the SpO2 gradually decreased to 0.60,and the extracorporeal circulation was immediately decided. After veno-venous ECMO (VV-ECMO) at 2:30 on July 11,the SpO2 was 0.90,and the blood gas was stable after multiple reexaminations. During July 12,there was still shortness of breath and poor oxygenation index. According to the MDT consultation opinion,during the emergency treatment combined with iNO treatment,oxygenation improved rapidly to 172 mmHg (1 mmHg≈0.133 kPa) and 190 mmHg after 1 hour and 2 hours,respectively. After 6 days,the oxygenation index stabilized between 222-285 mmHg. On July 17,the iNO support was gradually reduced and successfully removed. On July 21,a chest X-ray showed that the patient's lung lesions were significantly improved,and ECMO support parameters were gradually reduced until ECMO treatment was successfully discontinued. On August 3,the patient's consciousness returned to normal,and the indicators returned to normal. The ventilator-assisted breathing was stopped,and the high-flow oxygen therapy was observed after extubation. He was transferred from the ICU on August 8 and was discharged on August 15. ② Nursing points:we focus on personalized analgesia and sedation,and adjust the types and doses of sedative drugs in stages to reduce oxygen consumption and reduce complications. For the treatment of ARDS with ECMO combined with iNO to improve oxygenation,close monitoring and supportive care were carried out. Special attention was paid to the fixation of ECMO pipeline and tracheal intubation in patients with morbid obesity and individualized fine skin care was implemented. Actively prevent the potential complications of ICU acquired myasthenia,and carry out phased psychological nursing to establish rehabilitation confidence. Conclusion ECMO combined with iNO treatment requires professional teamwork,close observation,effective nursing and perfect monitoring technology to ensure the safety of patients with severe ARDS morbid obesity,reduce complications and improve prognosis,which has important reference significance for relevant medical practice.
